Provider Demographics
NPI:1609177856
Name:TRI-COUNTY ORTHOPAEDIC CENTER, PA
Entity Type:Organization
Organization Name:TRI-COUNTY ORTHOPAEDIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MANDUME
Authorized Official - Last Name:KERINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-326-8115
Mailing Address - Street 1:701 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7313
Mailing Address - Country:US
Mailing Address - Phone:352-326-8115
Mailing Address - Fax:352-326-4186
Practice Address - Street 1:701 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7313
Practice Address - Country:US
Practice Address - Phone:352-326-8115
Practice Address - Fax:352-326-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy